HNE’s Behavioral Health (BH) department utilizes the National Committee for Quality Assurance’s Health Enhancement Data and Information Set (HEDIS®*) measures to evaluate and improve the BH services available to our members.  We want to share information about the BH HEDIS measures as well as some of the interventions we are doing to help improve compliance.

1.  Follow-up after Hospitalization for Mental Health (the percentage of members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who were seen on an ambulatory basis or were in intermediate treatment with a mental health provider on day of discharge or within 7/30 days).  This is important because timely outpatient follow-up care has been shown to reduce readmission rates. 

HNE’s Interventions:

• To encourage members to attend a first follow-up appointment within 7 days of discharge and a second follow-up appointment within 30 days, HNE implemented a “Voucher Program.”  Through the “Voucher Program,” HNE pays the member’s co-pay for the first five follow-up appointments.  Vouchers have been sent to participating hospitals to give to members prior to discharge.  HNE also send the vouchers to members’ homes.
• The HNE BH department staff provide telephone outreach to members on days 2, 4, 10, and 21 post-discharge from a mental health facility.  Through this direct outreach to members, HNE BH department staff encourage members to receive follow-up care in an effort to reduce another hospitalization.

2.  Antidepressant Medication Management

Optimal Practitioner Contacts for Medication Management (the percentage of members 18 years of age and older who were diagnosed with a new episode of depression and treated with antidepressant medication, and who had at least three follow-up contacts with a practitioner coded with a mental health diagnosis during the 84-day [12-week] Acute Treatment Phase.  At least one of the three follow-up contacts must be with a prescribing practitioner).

Effective Acute Phase Treatment (the percentage of members 18 years of age and older who were diagnosed with a new episode of depression, were treated with an antidepressant medication, and remained on the antidepressant medication during the entire 84-day [12-week] acute treatment phase).

HNE Interventions:

• The HNE BH department staff encourage and support patients diagnosed with a new episode of depression to fill antidepressant prescriptions for the entire 12-week acute phase of treatment.  Through direct outreach to members, HNE BH department staff encourage members attend follow-up appointments with their psychiatrist or PCP for antidepressant medication monitoring.

Effective Continuation Phase Treatment (the percentage of members 18 years of age and older who were diagnosed with a new episode of depression and treated with an antidepressant medication, and remained on the antidepressant medication for at least 180 days).

HNE Interventions:

• The HNE BH department provides education to members about depression.  A three-part series in “Member Matters” (HNE’s member publication) on depression encourages member to remain on their medication as prescribed.  This information is also available in a brochure format. 
• The HNE BH department has sent information letters and brochures about depression to members diagnosed with depression and prescribed an antidepressant.  This educational outreach encourages members to continue to see their providers and remain on medication.

3.  Initiation of Alcohol or other Drug Treatment (the percentage of members (18-65) with an alcohol or other drug-related diagnosis who initiate treatment through inpatient or outpatient services for AOD and have an additional AOD service within 14 days).

HNE Interventions:

• To encourage members to attend a first follow-up appointment within 7 days of discharge and a second follow-up appointment within 14 days, HNE implemented a “Voucher Program.”  Through the “Voucher Program,” HNE pays the member’s co-pay for the first five follow-up appointments.  Vouchers have been sent to participating hospitals to give to members prior to discharge.  HNE also send the vouchers to members’ homes.
• The HNE BH department staff provide telephone outreach to members on days 2, 4, 10, and 21 post-discharge from a substance abuse facility.  Through this direct outreach to members, HNE BH department staff encourage members to receive follow-up care in an effort to maintain sobriety and reduce another hospitalization.
• The HNE BH department provides education to members about substance abuse.  A three-part series in “Member Matters” (HNE’s member publication) on substance abuse encourages member to continue in treatment and seek out additional support to maintain sobriety.  This information is also available in brochure format.  Copies of the brochure have been sent to participating providers.

4.  Follow-up Care for Children Prescribed ADHD Medication (the percentage of children newly prescribed ADHD medication who have at least 3 follow-up care visits within a 10-month period, one of which is within 30 days of when the first ADHD medication was dispensed).

HNE Interventions:

• The HNE BH department provides education to members about ADHD.  A three-part series about ADHDin “My Health Matters ” (HNE’s member publication) provides information and suggestions to parents/guardians of children with ADHD.  This information is also available in brochure format.  Copies of the brochure have been sent to participating providers.
• HNE developed additional ADHD Guidelines that recommend a second appointment within 30 days of medication being prescribed and at least two more follow-up appointments occur within a 9-month period of the second appointment.  These new guidelines were made available on hnn.com (click here).
• The HNE BH department has sent information letters and brochures about ADHD to parents/guardian of members diagnosed with ADHD and prescribed medication for ADHD.  This educational outreach provides information to parents about ADHD, how medication can help, and other helpful tips on coping with ADHD.

* HEDIS is a registered trademark of the National Committee of Quality Assurance (NCQA)